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The Other White Coat Phenomenon

Abraar Karan, UCLA medical student, writes: The physician-patient interaction is the most essential aspect of medical practice and has been shown to significantly impact the quality of care and direct health outcomes of patients. Several factors influence this relationship, one of which is the physical appearance of the physician, particularly his or her attire. The traditional view, which many studies have now directly demonstrated, is that patients are most confident and trusting of physicians in white coats, followed by those in scrubs, and then by those in formal attire and lastly those in casual dress. This has been indicated to be true not only in adults, but even in pediatric patients who are typically depicted as having an aversion to items associated with the doctor’s office, such as white coats.

Abraar Karan

However, in a recent op-ed, I described one of my first patient experiences while wearing a white coat. As opposed to feeling empowered, I felt very conscious of the numerous implications that my clothing could have on the patient, including arousal of fear, mistrust, and inferiority, and I noticed similar signs of discontent from the patient herself. I found this feeling to be true throughout my patient visits in the hospital, which I contrasted with the chaplain who was not wearing a white coat and who was well received by most of the patients.

Isolating the white coat as the only cause of the uneasiness is not possible. As medical students, we are instructed to mostly observe and not interact with patients too much during the chaplain rounds and these artificial constraints likely contributed to some of the discomfort I was feeling. Still, it also felt strange internally to be the person looking down at the patient lying helplessly in the hospital bed while I was in a position of power as part of a profession which has an unforgettable history of maltreatment, abuse, and outright exploitation of the sick in numerous instances. While physicians indeed offer medical treatment, it occurred to me during that day that they don’t always provide the support and humanistic care that the chaplain did, a type of care that in many ways is just as important.

Up until that point in my life, I only had the perspective of being a patient, looking up at the figure in the white coat. As a patient, while I never felt particularly intimidated by my physicians, I also come from a background of socioeconomic privilege. My family could easily afford a lawyer if anything went wrong, and given that my mother is a physician herself, I can see why I wouldn’t necessarily feel the same vulnerability as the woman who only speaks Spanish, who is a first generation immigrant, who comes from a lower income household, and who is not educated. She might be more easily subject to physician intimidation and mistreatment throughout her life than would I, and this could make all the difference.

While the studies citing patients’ white coat preference indicate people’s expectations and hopes of their physician’s attire, they do not delve into the psychological processes that this attire evokes in the patient. Nor do they stratify based on important factors such as education level, income, ethnicity, gender, or health insurance status, all which have been shown to directly correlate with levels of physician distrust, albeit in very complex ways.

Thus, we must consider the idea that the white coat and other accessories typically associated with “professionalism” in medicine may play a dual role—in many cases, instilling confidence in patients, while in some cases possibly associating the physician with previous negative experiences that the patient may have encountered in the healthcare system, particularly patients from minority groups who are unfortunately more likely to suffer abuses at some point during their care.

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